Quantitative Assessment of Contractile Reserve of Systemic Right
Ventricle in Post-Senning Children: Incorporating Speckle-tracking
Strain and Dobutamine Stress Echocardiography
Abstract
Introduction: The systemic load on the right ventricle (RV) after
Senning atrial switch leads to ventricular dysfunction. Quantitative
assessment of RV contractile reserve is mandatory to anticipate the need
for anti-failure treatment. We aimed to quantitatively assess RV
contractile reserve in Senning children by interrogating speckled global
longitudinal strain (GLS) during dobutamine stress echocardiography
(DSE). Methods: This prospective study compared thirty-one post-Senning
children (group I), and thirty controls (group II). In post-Senning
children, echocardiographic RV systolic function using automated
Simpson’s one-plane ejection fraction (RVEF), tricuspid annulus plane
systolic excursion (TAPSE), and RVGLS were recorded at rest and at peak
DSE. The contractile reserve was defined as improvement
>5% in RVEF, >2% in GLS, and/or to near
normal values in TAPSE. Results: RVEF, and TAPSE were significantly
lower in patients than controls (RVEF: 40.13±2.93% vs. 53.17±3.17%
respectively, P<0.001*, TAPSE: 13.81±1.26 vs. 17.45±2.93 mm
respectively, P<0.001*). Also, RVGLS was significantly worse
in Senning children than controls (-11.89±2.31% vs. -22.35±6.73%
respectively, P<0.001*). At peak DSE, contractile reserve was
not evident as measured by RVEF which increased none significantly to
42.47±2.80% (P=0.063). However, RVGLS improved significantly to
-15.78±0.93% (P<0.001*) and discovered the masked contractile
reserve in Senning children. The 19(61.29%) children who showed masked
contractile reserve (improvement in RVGLS>2%) underwent
continuation of anti-failure medications. Conclusions: Despite systemic
RV function in post-Senning children was impaired at rest and during
DSE, RVGLS was useful in quantitative assessment of masked contractile
reserve that was not evaluated by the ordinary RVEF, thus promoted
continuing anti-failure treatment.